Individual
DONNA M MANCUSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1301 ANTONINE ST, SUITE 500, NEW ORLEANS, LA 70115-3601
(504) 208-1035
(504) 891-3039
Mailing address
1301 ANTONINE STREET, SUITE 500, NEW ORLEANS, LA 70115
(504) 208-1035
(504) 891-3039
Taxonomy
Speciality
Code
Description
License number
State
102L00000X
Psychoanalyst
17303
LA
2084F0202X
Forensic Psychiatry Physician
17303
LA
2084P0800X
Psychiatry Physician
Primary
17303
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1371297
—
LA
Enumeration date
02/20/2006
Last updated
05/05/2015
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